Hip Impingement in Hockey Players: focus on butterfly style
goalies Christopher Larson, MD Twin Cities Orthopedics, Edina MN
Team Physician: Minnesota Wild David Rust, MD Orthopedic Sports
Medicine Fellow
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Overview Anatomy What is impingement? Affect on hockey
players/goalies Treatment options Other hip problems Future of
research and INJURY PREVENTION!!
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Hip = ball and socket joint Femur = thigh bone, head and neck
are involved Acetabulum = part of the pelvic ring Labrum =
cartilage ring on rim of acetabulum, mechanical bumper, seals the
hip joint (gasket) Articular cartilage = smooth gliding surface,
worn out in arthritic joints
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What is impingement? FAI = Femoral-Acetabular Impingement
Abnormal contact between the ball and rim/socket during activity
Results from a ball that is not perfectly round (CAM) or a socket
that is too deep (PINCER) Labral Tear Repetitive impingement leads
to pinching of the labrum between the ball and socket Labral tears
are common and often do not cause pain Important to recognize and
treat the underlying impingement
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Signs and Symptoms Deep sharp groin pain Worse with quick turns
Limited hip rotation/flexibility/stiff Unable to sit for prolonged
periods Groin / Front of the hip pain after activity Impingement
test = pain with hip flexion and internal rotation
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Must rule out other causes of pain Muscle and tendon strains
Contusions, fractures Athletic pubalgia / SPORTS HERNIA
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Butterfly Effect Evolution of style Rules and regulations
Increased rate of surgery Approximately 5-10 NHL goalies per year
have FAI surgery: JS Giguere Tim Thomas Niklas Backstrom Vesa
Toskala Patrick Roy Josh Harding Antero Niitimaki Rick DiPietro Ray
Emery Craig Anderson
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Butterfly Effect Skills that may place hip at risk pad flares
recovery pushes T-pushes/One foot stops One knee down on post
butterfly drops
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Treatment Options First step should be to work with coaches and
athletic trainers to identify likely cause of pain Examination
(with experienced provider) and regular x-rays will confirm
diagnosis When should an MRI be considered? Recent study found
positive MRI finding in 77% of asymptomatic professional and NCAA
hockey players
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FAI X-Rays
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Treatment Options Anti-inflammatory meds, rest, ice
Modifications in technique and equipment, decreased repetitions
Therapy can work on strengthening core muscles and hip rotators
Numbing injections can assist in determining the source of pain,
but cortisone is usually avoided in young patients
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Treatment Options When should surgery be considered? Unable to
perform athletics despite non-surgical treatment Pain with daily
activities In our experience, athletes that have problems at a
younger age are more likely to eventually need surgery and are at
risk for more significant hip damage
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Hip Arthroscopy Dr Larson has published over 40 articles
regarding hip injuries in athletes & has operated on over 50 US
and European Hockey Goalies from high school to the professional
level in the last 3 years as a result of Impingement and disabling
pain. We are currently conducting several studies looking at the
anatomy of the Hockey Goalie. Before SurgeryAfter Surgery
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Can we prevent impingement? Shape of hip develops over time
while the body is growing Primarily takes shape during adolescent
growth spurt Ages 10-14 in girls and 12-16 in boys Depends on type
of activity and number of repetitions May be similar to throwing
injuries in youth baseball
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Possible preventive strategies core fitness program for young
goalies to strengthen muscles and/or maintain flexibility Improve
upright Posture in butterfly and splits positions skill repetition
limits in practice greater off-season time, cross-training
equipment limitations or improvements
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What does the future hold? Research looking at hockey goalies
and players of all ages to find trends and identify who is at risk
Rules and regulations to help protect athletes from injury
Guidelines and recommendations for youth athletes, parents, and
coaches
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Research Study: Cam Impingement in Butterfly Goalies Goal is to
better understand, predict, and prevent hip injuries Hockey
goalies, hockey players, non-hockey players, with or without
symptoms, ages 10-40 No cost to enroll Participants will complete
questionnaire, examination, and x-rays No personal identifying
information Gain knowledge with respect to the RISK of developing
HIP problems based on the Examination and Xrays Minimal physical
risk Radiation from x-ray less than the typical annual exposure for
an average Minnesota resident
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Research Study: Cam Impingement in Butterfly Goalies
Participation requires signed consent (adults and parent/guardian)
and assent (adolescent) If interested please contact: Becky Stone @
[email protected] or [email protected] Dave Rust
@ [email protected]@fairview.org